Selection of physiotherapeutic methods and their effectiveness in rehabilitation of spastic hand in post-stroke patients
Journal Title: Rehabilitacja Medyczna - Year 2006, Vol 10, Issue 3
Abstract
Subject. The study evaluated the impact of applied physiotherapeutic treatments on improvement in functioning of the paretic hand in post-stroke patients. Artificial neural networks modelling system was employed to illustrate the effectiveness of various treatments and treatment selection criteria.Material and methods. A group of 43 patients with hemiparesis following cerebral stroke were enrolled. Time elapsed since stroke occurrence ranged from 3 to 36 weeks. The following tests: the Brunnström test, modified Ashworth scale, grip strength test, thumb-opposition test, and closed fist test were administered before and after 15 days of treatment. Treatment types: tonolysis + kinesitherapy (active, active and passive, or passive exercises) or topical cryotherapy + kinesitherapy (as above). the type of therapy with physical agents was selected randomly, while kinesitherapy was determined by the pretreatment hand function.Results. The administered tests demonstrated an improvement in paretic hand functioning (based on the Brunnström test) for both tonolysis and cryotherapy treatments. Significantly higher improvement was achieved in patients treated with tonolysis and kinesitherapy (all exercise types). We found that cryotherapy has a greater impact on improving hand spasticity. Affected hand strength improvement was observed in patients treated with tonolysis, while in patients treated with cryotherapy, healthy hand strength improvement was noticed. Improvement in the thumb opposition test and the closed fist test was achieved with “passive” and “active and passive” exercises, regardless of the physiotherapy type. Relationship among “time since stroke”, treatment types and test improvements was analysed. Significantly higher improvements were achieved when the therapy was applied earlier, 3-15 weeks after stroke.Conclusions. The administered tests demonstrated a higher impact of tonolysis on the improvement in the Brunnström test, while cryotherapy proved to be more effective in reducing spasticity. Application of artificial neural network technology and modelling treatment process enable selection of the most effective treatment methods for a particular patient.
Authors and Affiliations
Irena Pasternak-Mlądzka, Renata Dobaczewska, Dariusz Otręba, Zbigniew Mlądzki
Keywords
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